Paediatric
Strabismus
Also known as: strabismus, squint, eye turn child, constant unilateral deviation, intermittent squint, pseudoesotropia, infantile esotropia, infantile exotropia
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Misalignment of the visual axes, constant or intermittent, that parents commonly notice as an eye that turns, whether inward, outward, upward or downward. Cover testing or corneal reflex assessment shows a manifest deviation, and reduced stereopsis, suppression, amblyopia or significant refractive error frequently coexist. An acute or new-onset deviation is a different clinical problem from a longstanding childhood turn and warrants prompt assessment.
Recognition
Symptoms: what patients report
- Parents notice one eye turning in, out, up, or down.
- Eye turn may be intermittent or constant.
- Child may have reading avoidance, poor attention to near work, or reduced depth awareness.
Signs: what the examination shows
- Manifest deviation on cover testing or corneal reflex assessment.
- Reduced stereopsis or suppression may be present.
- Amblyopia or refractive error may coexist.
- Subtype clues may include near hyperopic esotropia, distance/fatigue-related exotropia, apparent crossing with normal Hirschberg and cover test, or ocular motility restriction with head posture.
- A stable long-standing pattern is clinically different from sudden-onset deviation.
What OptoGuide™ covers for strabismus
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Strabismus — AAPOS
- Esotropia and Exotropia Preferred Practice Pattern®. Sprunger DT, Lambert SR, Hercinovic A, et al. Ophthalmology. 2023;130(3):P179-P221.
- Clinical Stage of Retinoblastoma Based on Presenting Signs of 4578 Patients From 121 Countries. Yanagihara RT, Takayesu JSK, Crotty EE, et al. Ophthalmology. 2025;132(9):1045-1053.
- Acute Strabismus in Neurological Emergencies of Childhood: A Retrospective, Single-Centre Study. Garone G, Ferro V, Barbato M, et al. European Journal of Paediatric Neurology : EJPN : Official Journal of the European Pae
- Presenting signs of retinoblastoma. Abramson DH, Frank CM, Susman M, et al. J Pediatr. 1998;132(3 Pt 1):505-8.
- Paediatric Ophthalmology State-wide Referral Criteria for Public Outpatient Services (v1.0, May 2024). NSW Health.
- RANZCO Paediatric Referral Guidelines (April 2025). Royal Australian and New Zealand College of Ophthalmologists.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.